● Establishing and maintaining the appropriate training and medical records for each employee. ● Ensuring that all items in the office are properly labeled and indicated. (CDC, 2016b) Although originally published in 1992 and updated in 2001, the OSHA Bloodborne Pathogens Standard remains in effect today (OSHA, 2001). All dental personnel should be familiar with all the provisions of this standard. More information on this document can be found in the Resources section of this course. Standard Precautions • Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting in which healthcare is delivered. These practices are designed to both protect healthcare workers (HCWs) and prevent HCWs from spreading infections among patients. • Standard precautions apply to contact with: ○ Blood. ○ All body fluids, secretions, and excretions except sweat, regardless of whether they contain blood. ○ Non-intact skin. ○ Mucous membranes. • Standard precautions are employed in the care of all patients in the delivery of routine dental care and include: ○ Hand hygiene. ○ Use of PPE (e.g., gloves, gowns, masks, eye protection). ○ Safe injection practices. ○ Safe handling of potentially contaminated equipment
● BBP training on an annual basis for all employees with occupational exposure. ● Providing and maintaining appropriate PPE and training employees on how it is used properly. ● Establishing a mechanism for post exposure monitoring, follow-up, and post exposure prophylaxis. ● Providing HBV vaccination free of charge to all employees with occupational exposure. ● Monitoring employee work practices and behaviors to ensure compliance.
Table 1: Standard vs. Universal Precautions Standard precautions combine the major features of universal precautions and body substance isolation. Universal Precautions
• This is an approach to infection control in which blood and certain body fluids are treated as if known to be infectious for: ○ HIV.
○ HBV. ○ HCV. ○ Other BBPs.
• Universal precautions were based on the concept that all blood (and body fluids that might be contaminated with blood) should be treated as infectious because patients with bloodborne infections are often asymptomatic or unaware that they are infected. Body Substance Isolation • Body substance isolation protects against pathogens that may exist in body substances and applies in all patient encounters regardless of the diagnosis (the same way, every day, for every patient).
or surfaces in the patient environment. ○ Respiratory hygiene/cough etiquette.
Note : U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2003, Dec. 19). Guidelines for infection control in dental health-care settings. Morbidity and Mortality Weekly Report, 52 (RR-17), 1-61; U.S. Department of Labor, Occupational Safety and Health Administration (1992). Bloodborne Pathogens Standard. 29 C.F.R. §1910.1030; U.S. Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule . Fed. Reg. 66:5317 (2001), 25. As amended from and includes Bloodborne Pathogens Standard. 29 CFR §1910.1030. Occupational exposure to
bloodborne pathogens; final rule . Fed. Reg. 56:64174, 82. Centers for Disease Control and Prevention Although OSHA’s mission is to protect employees in the workplace, the Centers for Disease Control and Prevention (CDC) is tasked with protecting the public health of the entire U.S. population. The CDC is not a regulatory agency, but it does recommend infection control precautions often used to form the basis for regulations set by state licensing boards and OSHA. As cases of HIV/AIDS began to increase in the 1980s, concern about transmission of HIV/AIDS in the dental office began to mount. At that time, infection control in dentistry was rudimentary, contact with blood was frequent, the number of percutaneous exposures was high, the use of barriers was almost nonexistent, and disinfection and sterilization practices were questionable. Accordingly, the CDC published Recommended Infection Control Practices for Dentistry in 1986, but the recommendations were generally ignored by the profession as a whole. However, by the early 1990s and the publication of the Bloodborne Pathogens Standard, most dentists realized that infection control was important for their safety and for the safety of their patients and staff. In order to enable dental professionals to provide oral health care as safely as possible, the CDC published an updated
Recommended Infection Control Practices for Dentistry in 1993 (which closely paralleled the Bloodborne Pathogens Standard). This document provided guidance to the dental profession until December 19, 2003, when the CDC published the new, evidence-based, Guidelines for Infection Control in Dental Health-Care Settings – 2003 (CDC, 2003). As new diseases and technologies emerge, new infection control practices must be introduced, and the 2003 CDC guidelines recommended significant modifications and updates in the infection control practices for the dental profession. All dental professionals should be familiar with the infection control principles contained in this document. More information on this document can be found in the Resources section of this course. Although published almost two decades ago, the Guidelines for Infection Control in Dental Health-Care Settings – 2003 are still the most current dentistry-specific infection control guidelines from the CDC, and many state boards have adopted them as their infection control regulations. More recently, the increasing number of HAIs and the propagation of many drug-resistant infections occurring in outpatient settings, not to mention the COVID-19 pandemic, have
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